VillaNueva C B, Ludwig S T, Shroyer A L, Deegan N I, Steeger J E, London M J, Sethi G K, Grover F L, Hammermeister K E
PSOCS Study, Denver Veterans Affairs Medical Center, Colorado, USA.
Med Care. 1995 Oct;33(10 Suppl):OS59-65. doi: 10.1097/00005650-199510001-00007.
Nurses play an invaluable role as key members of the cardiac surgery patient's medical care team. Over the last century, the nursing profession has become more independent and autonomous. Despite the widespread use of nursing quality indicators, the effect of nursing-specific processes and structures of care on patient outcomes is unknown. Thus, the Processes, Structures, and Outcomes of Care in Cardiac Surgery (PSOCS) study was initiated, in part, to determine the potential effect of nursing processes and structures of care on cardiac surgery patients' risk-adjusted outcomes. In this article, the authors summarize the key components of nursing structures of care incorporated in the PSOCS study. Nursing process variables were not sufficiently designed into the study to address hypotheses relating nursing care processes to patient outcomes. An analysis of the pilot test data from September 1992 to September 1993 demonstrated potentially important variations between the six pilot centers regarding nursing care provider profiles (eg, educational preparation, specialty certification, and experience levels) and nursing staff ratios (eg, within the surgical intensive care unit). When linked to risk-adjusted patient outcomes, these variations in nursing structure of care may offer important insights toward improving the quality of care of cardiac surgery patients.
护士作为心脏手术患者医疗护理团队的关键成员，发挥着极其重要的作用。在过去的一个世纪里，护理专业变得更加独立和自主。尽管护理质量指标被广泛使用，但特定护理流程和护理结构对患者预后的影响尚不清楚。因此，启动心脏手术护理流程、结构与预后（PSOCS）研究的部分目的是确定护理流程和护理结构对心脏手术患者风险调整后预后的潜在影响。在本文中，作者总结了PSOCS研究中纳入的护理结构的关键组成部分。护理流程变量在研究中设计得不够充分，无法解决将护理流程与患者预后相关联的假设。对1992年9月至1993年9月试点测试数据的分析表明，六个试点中心在护理提供者概况（如教育背景、专业认证和经验水平）和护理人员比例（如在外科重症监护病房内）方面存在潜在的重要差异。当与风险调整后的患者预后相关联时，这些护理结构的差异可能为改善心脏手术患者的护理质量提供重要见解。
